Shifting from axillary dissection to targeted axillary surgery after neoadjuvant treatment: the evolving management of occult breast cancer in a monoinstitutional series of 114 patients.
Elisa Vicini, Viviana Galimberti, Maria Cristina Leonardi, Sabrina Kahler-Ribeiro-Fontana, Andrea Polizzi, Salvatore Petitto, Eleonora Pagan, Vincenzo Bagnardi, Emilia Montagna, Matteo Cavallone, Pietro Caldarella, Mattia Intra, Paolo Veronesi
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引用次数: 0
Abstract
Purpose: The use of neoadjuvant systemic therapy for primary breast cancer can achieve tumor shrinkage, enabling less invasive surgical treatments, such as breast-conserving surgery instead of mastectomy, and sentinel node biopsy instead of axillary dissection. In recent years, an increasing number of studies have explored the use of primary systemic therapy for occult breast cancer with axillary presentation. These studies suggest that a more conservative approach, involving targeted axillary surgery could be cautiously proposed for occult breast cancer after neoadjuvant chemotherapy in selected patients. In cases where a complete pathological response in the lymph nodes is achieved, there may also be the possibility to omit radiotherapy.
Methods: We retrospectively reviewed surgical interventions for carcinoma of unknown primary (CUP) syndrome with axillary presentation at the European Institute of Oncology from April 2004 to October 2022. Demographic and clinicopathological characteristics of the patients were collected and follow-up information has been updated.
Results: A total of 114 patients who underwent axillary surgery for occult breast cancer were included. The 5-year disease-free survival was 74.5%, while overall survival was 88.5%. A total of 22.8% of patients underwent neoadjuvant treatment. Complete pathological response was achieved in 38.5%. Patients with complete nodal pathological response showed fewer events compared to patients with no complete pathological response after neoadjuvant treatment.
Conclusion: Although the sample size is limited, recent advances in breast cancer multimodal treatment indicate that targeted axillary surgery may be considered for the rare clinical presentation of occult breast cancer after neoadjuvant treatment.
Trial registry: Trial registration number UID 4184 24/07/2024 "retrospectively registered".
目的：原发性乳腺癌采用新辅助全身治疗可使肿瘤缩小，使手术治疗的创伤性更小，如保乳手术代替乳房切除术，前哨淋巴结活检代替腋窝清扫。近年来，越来越多的研究探索了原发性全身治疗以腋窝表现的隐匿性乳腺癌的应用。这些研究表明，对于新辅助化疗后的隐匿性乳腺癌患者，可以谨慎地提出一种更保守的方法，包括靶向腋窝手术。在淋巴结达到完全病理反应的情况下，也有可能省略放疗。方法：我们回顾性地回顾了2004年4月至2022年10月在欧洲肿瘤研究所（European Institute of Oncology）对具有腋窝表现的不明原发癌（CUP）综合征的手术干预。收集了患者的人口学和临床病理特征，并更新了随访信息。结果：114例隐匿性乳腺癌患者接受腋窝手术治疗。5年无病生存率为74.5%，总生存率为88.5%。共有22.8%的患者接受了新辅助治疗。38.5%的患者病理完全缓解。在新辅助治疗后，有完全淋巴结病理反应的患者比没有完全病理反应的患者发生的事件更少。结论：虽然样本量有限，但乳腺癌多模式治疗的最新进展表明，对于隐匿性乳腺癌在新辅助治疗后罕见的临床表现，可以考虑腋窝靶向手术。试验注册：试验注册号UID 4184 24/07/2024“回顾性注册”。
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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